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Primary care II > Menopause > Flashcards

Menopause Flashcards

1
Q

menopause occurs with

A

1000

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2
Q

Changes with estrogen loss

A 
increase ldl decrease hdl 
bone loss 
CNS- hot flashes nightsweats memory 
GI- decreased motility 
CV- vasodilation atherosclerosis 
GU- loss support vaginal vault
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3
Q 
Perimenopause
occurs \_\_\_\_ 
estrogen levels\_\_\_\_ 
biggest complaint\_\_\_\_ 
duration \_\_\_\_\_
A

occurs in 40s
estrogen levels rise/fall- unstable
biggest c/o menstrual irregularity
2-8 years (avg. of 5)

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4
Q

undergo menopause at earlier age

A 
smokers 
type I dm 
increased altitude 
undernourished/vegetarian
NO LINK to FH 
cancer
hysterectomy
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5
Q

what does progesterone do to uterus?

A

keeps it thin

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6
Q

women c/o skipping period and when it comes its heavy..what do you do?

A

biopsy
then progesterone only
progesterone iud
combo prog/estrog

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7
Q

women c/o nightsweats, moody irritable, light periods…what do you do?

A

SSRI: prozac, effexor

combo prog/estro

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8
Q 
menopause 
end of \_\_\_\_\_\_\_ 
cessation of menses for \_\_\_\_\_ 
surgical removal of \_\_\_\_\_\_ 
age \_\_\_\_\_\_
A

end of reproductive life
cessation of menses for 1 year
surgical removal of ovaries
age 50

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9
Q 
menopause etiology 
results from changes in \_\_\_\_\_ 
atresia of \_\_\_\_\_\_ 
fewer follicles decreased production of \_\_\_\_\_ (most potent) 
then \_\_\_\_\_ becomes primary E2 from \_\_\_\_\_
A

results from changes in ovaries
atresia of follicles
fewer follicles, decreased production of estradiol (most potent) E2
estrone becomes primary (from adipose tissue)

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10
Q

Lab tests
FSH >______ indicates menopause
Estradiol

A

FSH>40

Estradiol

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11
Q

menopause tx begins with

A

education

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12
Q

Hormone replacement therapy
Used for ________ menopause
Must be used in women with _________

A

used for symptomatic menopause

must be used in women with an intact uterus

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13
Q

Estrogen replacement therapy for women with_____

A

estrogen replacement therapy for women with hysterectomy

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14
Q

hrt forms

A

estrog/prog cyclic or continuous
(estrogen qd and prog 10 days)
continuous is better

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15
Q

Benefit of HRT

A

dec. flashes
improve genitourinary
dec. osteoporosis and cardiac (1st year inc.)
?dementia

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16
Q

Contraindications for HRT

A 
undx vaginal bleeding 
pregnancy 
hx thromboembolic episodes
liver disease 
cancer breast resp tract
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17
Q

HRT precaution

A 
type 1 dm 
gallbladder disease 
>1ppd 
obesity/elevated trig
fmh breast ca 
fibroid uterus (stimulated by estrogen) 
hx peripheral vascular 
migraines
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18
Q

HRT candidate

A 
menopause within 5 years 
good health 
no risk factors heart or breast (no first degree relative) 
nonsmoker 
nonobese 
normal bs and bp 
mod-sev sx
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19
Q

HRT risks

A

blood clots
gall bladder disease
breast cancer
cardiac in 1st year if prior heart disease

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20
Q

Breast cancer risk with HRT

A

10 increased risk

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21
Q

estrogen alone can be used for

A

7 years

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22
Q

estrogen progesterone can be used for

23
Q

estrogen replacement therapy drug options

A

premarin
menest
estradiol
transdermal (best- avoids liver, less trig and lipid)

24
Q

HRT drug options

A

provera or prometrium
combined: prempro, premphase, femHRT, activella, ortho-prefest, combipatch
duavee- estrogen with bazedoxifene ( reduce effect of estrogen on uterus)

25
SE HRT
BTB (if continues over a year then eval) Fibroids Allergic Virilization (testosterone products) Progesterone: breast tenderness, fluid retention, weight gain, depression, irritability
26
Sleep options
melatonin gabapentin lunesta
27
Vasomotor pharmacology
``` brisdelle (paroxetine) effexor gabapentin clonidine SSRI: paxil, prozac, zoloft ```
28
In 5-7 years following menopause a women will lose up to ______ of bone density
20%
29
Osteoporosis risk factors
``` history fx >50 low E2 women caucasian thin ```
30
Bone density scan should be done on....
``` >65 fh small frame smoker, etoh, glucocorticoid postmenopausal not on hrt low activity early menopause hx rib, hip, forearm, vertebral fx ```
31
USPSTF osteoporosis screening recommendation
65+ or 60 if increased risk
32
Dexa screening ____ x ray measures __,___,___
dual energy x ray | hip spine wrist
33
BMD scores and retesting
- 1 normal: 10-15 years - 1 to -2.5 osteopenia: 2-5 years - 2.5 osteoporosis: every year
34
Frax test what it shows
BMD + predicts risk of breaking bone in 10 years
35
BMD results and treatment Normal Low bone density Osteoporosis
normal: ca and vit d healthy diet exercise low bd: same + fosamax 1/2 strength osteoporosis: same+ full strength + refer to endocrinology
36
Calcium and vitamin d requirement men? over 65?
1200 mg whether HRT or not 400-800 vitamin D men: 1000 mg over 65: 1500 mg
37
2 classes of osteoporosis meds and what their goals are
antiresorptive (biphosphonates): slow bone loss | anabolic parathyroid hormone: build bone
38
biphosphonates dec risk of fracture by _____ over _____
50% over 2-4 years
39
How to take biphosphonates
1st thing in the morning on an empty stomach with glass of water 30 mins before eating drinking stay upright
40
Boniva aka ____ is a ____ and is rx by ______ it is an __________
boniva aka ibandronate is a biphosphate rx by endocrine, it is an IV medication (or oral)
41
risedronate aka
actonel atelvia
42
zoledronic acid aka | prevention and treatment of
reclast | prevention and tx of steroid induced osteoporosis
43
SE biphosphonates
``` bone, joint, muscle pain nausea, heartburn uveitis ONJ- jaw necrosis spontaneous fx of femurs: >5 years drug holiday ```
44
parathyroid hormone drugs for osteoporosis
teriparatide or forteo denosunmab or prolia *injections*
45
``` SERM aka is a _____ decreases ______ and _____ increases ____ contraindications: SE: + effect on ____, no risk of _______ ```
``` reloxifene or evista is an estrogen modulator decreases bone turnover and resorption increases bone density contraindications: thromboembolic risk DVT in first 4 months SE: leg cramps, hot flashes + effect chol, no risk breast/uterus ```
46
``` Calcitonin is for ____ for women >_____ suppresses ______ form_____ alternate____ contraindications____ SE: ```
``` spine > 5 years postmenopausal suppresses osteoclast activity form nasal spray alternate nostrils contraindications: allergy or salmon SE: rhinitis, arthralgia, back pain, HA, epistaxis ```
47
Interstitial cystitis aka absence of ____ coexists with what worsens symptoms??
bladder pain syndrome absence of other etiology coexcists with fibromyalgia, ibs worsen sx: caffeine, etoh, fruit, tomato, spicy food
48
Sx interstitial cystitis
``` discomfort full relief with voiding urgency, frequency, nocturia pelvic tenderness pain with sex *urinary incontinence not a symptom gradual onset, >6 months ```
49
Causes interstitial cystitis
``` unknown ?mast cell- inflammatory, histamine urine changes in nerves immune system ```
50
Findings in interstitial cystitis
tenderness lower abdomen negative: urine, chlamydia, cystoscopy dx: postvoid residual urine volume to r/o obstruction
51
Tx interstitial cystitis
``` Antihistamines (atarax, claritin) TCA (imipramine, amitriptylline) Pentosan (urology) Anti-inflammatories (advil) Urology for infusions (heprain, dimethyl sulfoxide) ```
52
Overactive bladder def. and char.
muscles of bladder contrx involuntarily urgency incontinence (maybe) frequency, nocturia (usually)
53
Risk fx for overactive bladder
``` Neurological High urine prod (diabetes, kidney disease) Medications UTI Bladder tumor/stone Outflow obstruction (prostate, constipation) Caffeine/ETOH Cognitive decline Ambulating Constipation Incomplete emptying ```
54
Tx overactive bladder
``` Fluid restrx Avoid caffeine Pelvic floor exercises Medications: antimuscarinic Oxybutynin (ditropan) Tolterodine (detrol) caution glaucoma (dry eyes, constipation) ```

Primary care II (13 decks)

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